侵襲性肺遲緩曲霉病一例報道_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

黃超 ¹ ,  劉倩茜 ¹ , 卿雯琪 ¹ , 郭珊珊 ¹ , 陳云鳳 ¹ , 陳俊 ²

1. ;
2. ;

Corresponding?author：

劉倩茜, Email: chuan112500@126.com

Keywords：

遲緩曲霉; 侵襲性肺曲霉菌病; 艾沙康唑

DOI：

10.7507/1671-6205.202307016

Video：

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目的通過本病例及綜述以提升對侵襲性肺遲緩曲霉病早期病原學診斷的重視，并為治療方案提供參考依據。方法回顧我科診治的1例COVID-19感染后繼發的侵襲性肺遲緩曲霉病患者的臨床資料，復習既往文獻總結分析肺遲緩曲霉病的臨床表現、診斷及治療用藥方案。結果患者79歲，老年男性，咳嗽、咳痰伴呼吸困難4月余。胸部CT提示：雙肺數個結節灶，部分結節內空洞形成；散在實變影。G實驗、GM結果陰性。氣管鏡肺泡灌洗液送檢mNGS查見遲緩曲霉菌。給予伏立康唑治療后效不佳，且繼發肝功能異常，調整為艾沙康唑治療后臨床癥狀及肺部影像學征象好轉。復習文獻，共有12例個案報道，其中8例存在免疫抑制狀態，4例合并慢性阻塞性肺病，6例為器官移植術后。臨床選藥以伏立康唑和兩性霉素B居多，雖經治療仍有66.7%（8例）患者在確診后7周內死亡。結論本例為國內外首次使用艾沙康唑成功治療侵襲性肺遲緩曲霉病的報告。侵襲性肺遲緩曲霉病屬于罕見病，免疫抑制狀態是其高危因素。該病進展迅速，具有高度耐藥性，預后差，病死率高，早期病原學診斷尤為關鍵。

Citation： 黃超, 劉倩茜, 卿雯琪, 郭珊珊, 陳云鳳, 陳俊. 侵襲性肺遲緩曲霉病一例報道. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(4): 271-274. doi: 10.7507/1671-6205.202307016 Copy

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25.	Lamoth F, Calandra T. Pulmonary aspergillosis: diagnosis and treatment. Eur Respir Rev, 2022, 31(166).
26.	陳欣, 林韌. 艾沙康唑臨床應用專家共識(2023版). 臨床血液學雜志, 2023, 36(05): 295-302.

1. Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis, 2016, 63(4): e1-e60.
2. Glampedakis E, Erard V, Lamoth F. Clinical Relevance and Characteristics of Aspergillus calidoustus and Other Aspergillus Species of Section Usti. J Fungi (Basel), 2020, 6(2): 84.
3. Nematollahi S, Permpalung N, Zhang SX, et al. Aspergillus lentulus: An Under-recognized Cause of Antifungal Drug-Resistant Aspergillosis. Open Forum Infect Dis, 2021, 8(8): b392.
4. Staab JF, Kahn JN, Marr KA. Differential Aspergillus lentulus echinocandin susceptibilities are Fksp independent. Antimicrob Agents Chemother, 2010, 54(12): 4992-4998.
5. Alhambra A, Catalan M, Moragues MD, et al. Isolation of Aspergillus lentulus in Spain from a critically ill patient with chronic obstructive pulmonary disease. Rev Iberoam Micol, 2008, 25(4): 246-249.
6. Montenegro G, Sanchez PS, Jewtuchowicz VM, et al. Phenotypic and genotypic characterization of Aspergillus lentulus and Aspergillus fumigatus isolates in a patient with probable invasive aspergillosis. J Med Microbiol, 2009, 58(Pt 3): 391-395.
7. Yoshida H, Seki M, Umeyama T, et al. Invasive pulmonary aspergillosis due to Aspergillus lentulus: Successful treatment of a liver transplant patient. J Infect Chemother, 2015, 21(6): 479-481.
8. Shivasabesan G, Logan B, Brennan X, et al. Disseminated Aspergillus lentulus Infection in a Heart Transplant Recipient: A Case Report. Clin Infect Dis, 2022, 75(7): 1235-1238.
9. Ahmed J, Singh G, Xess I, et al. Emerging Aspergillus lentulus infections in India. Indian J Med Microbiol, 2022, 40(1): 160-162.
10. Bastos VR, Santos DW, Padovan AC, et al. Early invasive pulmonary aspergillosis in a kidney transplant recipient caused by Aspergillus lentulus: first Brazilian report. Mycopathologia, 2015, 179(3-4): 299-305.
11. Zbinden A, Imhof A, Wilhelm M J, et al. Fatal outcome after heart transplantation caused by Aspergillus lentulus. Transpl Infect Dis, 2012, 14(5): E60-E63.
12. Gurcan S, Tikvesli M, Ustundag S, et al. A Case Report on Aspergillus lentulus Pneumonia. Balkan Med J, 2013, 30(4): 429-431.
13. Zhang H, Liu G, He L, et al. Life-threatening pulmonary coinfection with Mycobacterium tuberculosis and Aspergillus lentulus in a diabetic patient diagnosed by metagenome next-generation sequencing. BMC Infect Dis, 2023, 23(1): 88.
14. Imbert S, Normand AC, Cassaing S, et al. Multicentric Analysis of the Species Distribution and Antifungal Susceptibility of Cryptic Isolates from Aspergillus Section Fumigati. Antimicrob Agents Chemother, 2020, 64(12): e01374-20.
15. Balajee SA, Weaver M, Imhof A, et al. Aspergillus fumigatus variant with decreased susceptibility to multiple antifungals. Antimicrob Agents Chemother, 2004, 48(4): 1197-1203.
16. Alcazar-Fuoli L, Mellado E, Alastruey-Izquierdo A, et al. Aspergillus section Fumigati: antifungal susceptibility patterns and sequence-based identification. Antimicrob Agents Chemother, 2008, 52(4): 1244-1251.
17. Yu SY, Guo LN, Xiao M, et al. Clinical and Microbiological Characterization of Invasive Pulmonary Aspergillosis Caused by Aspergillus lentulus in China. Front Microbiol, 2020, 11: 1672.
18. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis, 2006, 42(10): 1417-1427.
19. Hoenigl M, Egger M, Price J, et al. Metagenomic Next-Generation Sequencing of Plasma for Diagnosis of COVID-19-Associated Pulmonary Aspergillosis. J Clin Microbiol, 2023, 61(3): e185922.
20. Gu L, Liu W, Ru M, et al. The application of metagenomic next-generation sequencing in diagnosing Chlamydia psittaci pneumonia: a report of five cases. BMC Pulm Med, 2020, 20(1): 65.
21. Zhang P, Chen Y, Li S, et al. Metagenomic next-generation sequencing for the clinical diagnosis and prognosis of acute respiratory distress syndrome caused by severe pneumonia: a retrospective study. PeerJ, 2020, 8: e9623.
22. Zhan W, Liu Q, Yang C, et al. Evaluation of metagenomic next-generation sequencing diagnosis for invasive pulmonary aspergillosis in immunocompromised and immunocompetent patients. Mycoses, 2023, 66(4): 331-337.
23. Diao Z, Han D, Zhang R, et al. Metagenomics next-generation sequencing tests take the stage in the diagnosis of lower respiratory tract infections. J Adv Res, 2022, 38: 201-212.
24. Qin Z, Zou Y, Huang Z, et al. Metagenomic next-generation sequencing contributes to the diagnosis of mixed pulmonary infection: a case report. Ann Clin Microbiol Antimicrob, 2022, 21(1): 52.
25. Lamoth F, Calandra T. Pulmonary aspergillosis: diagnosis and treatment. Eur Respir Rev, 2022, 31(166).
26. 陳欣, 林韌. 艾沙康唑臨床應用專家共識(2023版). 臨床血液學雜志, 2023, 36(05): 295-302.

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侵襲性肺遲緩曲霉病一例報道

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